Peritoneal Nebulization of Ropivacaine during Laparoscopic Cholecystectomy: Dose Finding and Pharmacokinetic Study

Abstract

Background. Intraperitoneal nebulization of ropivacaine reduces postoperative pain and morphine consumption after laparoscopic surgery. The aim of this multicenter double-blind randomized controlled trial was to assess the efficacy of different doses and dose-related absorption of ropivacaine when nebulized in the peritoneal cavity during laparoscopic cholecystectomy. Methods. Patients were randomized to receive 50, 100, or 150 mg of ropivacaine 1% by peritoneal nebulization through a nebulizer. Morphine consumption, pain intensity in the abdomen, wound and shoulder, time to unassisted ambulation, discharge time, and adverse effects were collected during the first 48 hours after surgery. The pharmacokinetics of ropivacaine was evaluated using high performance liquid chromatography. Results. Nebulization of 50 mg of ropivacaine had the same effect of 100 or 150 mg in terms of postoperative morphine consumption, shoulder pain, postoperative nausea and vomiting, activity resumption, and hospital discharge timing (>0.05). Plasma concentrations did not reach toxic levels in any patient, and no significant differences were observed between groups (P > 0.05). Conclusions. There is no enhancement in analgesic efficacy with higher doses of nebulized ropivacaine during laparoscopic cholecystectomy. When administered with a microvibration-based aerosol humidification system, the pharmacokinetics of ropivacaine is constant and maintains an adequate safety profile for each dosage tested.

Intraperitoneal nebulization of ropivacaine for control of pain after laparoscopic cholecystectomy -A randomized control trial

“…In our study, we used ropivacaine for intraperitoneal nebulization as it is associated with less toxicity and is equally effective as bupivacaine. In a dose-finding study by Allegri et al [ 12 ] 50 mg of nebulized ropivacaine was found to be effective in providing adequate analgesia in patients undergoing laparoscopic cholecystectomy. Further increase in the dose of ropivacaine did not provide any additional benefit.…”

Intraperitoneal nebulization versus intraperitoneal instillation of ropivacaine for postoperative pain management following laparoscopic donor nephrectomy

“…The plasma concentration remained consistent under the mean toxic plasma concentration. They also found that increasing the dose of ropivacaine from 50 mg to 150 mg did not reduce postoperative pain intensity, morphine consumption, incidence of PONV, or readiness for discharge, but was instead associated with the incidence of postoperative shivering [23].…”

“…The concentration (0.5%) and volume (20 ml) of ropivacaine in the instillation group was based on standard practice, and the lower volume (10 ml) and higher concentration (1%) of ropivacaine in the nebulization group was based on nebulization time (the Aeroneb Pro Ⓡ device can deliver 5 ml of solution in 5–8 min). Moreover, a recent study showed that increasing the dose of ropivacaine from 50 mg to 150 mg did not show any clinical benefit [23].…”

Intraperitoneal Instillation of Local Anesthetic (IPILA) in Bariatric Surgery and the Effect on Post-operative Pain Scores: a Randomized Control Trial

“…There have been studies conducted on the effectiveness of intraperitoneal local anesthetic in laparoscopic procedures including bariatric surgery. However, results from such studies are inconclusive; some demonstrated a reduction in post-operative pain [ 8 , 10 , 12 – 15 , 18 , 19 ] yet others found no difference [ 9 , 11 , 16 , 17 ]. Previous studies conducted on intraperitoneal local anesthetic in bariatric patients have administered a standardized volume of local anesthetic to every patient.…”